Kahn James G, Zhang Xiulan, Cross Lanny T, Palacio Herminia, Birkhead Guthrie S, Morin Stephen F
Institute for Health Policy Studies, University of California-San Francisco, 3333 California Street, Suite 265, San Francisco, CA 94118, USA.
Public Health Rep. 2002 May-Jun;117(3):252-62; discussion 231-2. doi: 10.1093/phr/117.3.252.
To examine access to and use of HIV highly active antiretroviral therapy (HAART) by race/ethnicity in Medicaid and the AIDS Drug Assistance Program (ADAP) in 1998 in four states.
The authors analyzed reimbursement claims and AIDS surveillance data in California, Florida, New York, and Texas. Study subjects were identified using diagnostic or medication codes specific to HIV. The race/ethnicity of program enrollees was compared to representation in the HIV epidemic to examine access. Claims for antiretroviral (ARV) use were compared to U.S. Public Health Service treatment guidelines to assess HAART use.
The authors identified 151,000 HIV-infected individuals in these two programs in the four states. Evidence of AIDS or symptomatic HIV was present in 78%-88% of enrollees in Medicaid, versus 31%-48% in ADAP. African Americans participated in Medicaid 10%-53% above and in ADAP 17%-31% below representation in the epidemic. Non-Latino whites exhibited the opposite pattern, being in Medicaid 5%-38% below and in ADAP 9%-65% above epidemic representation. Latinos participated more in ADAP (7%-31%), except in New York. HAART use over 90 days (July-September) ranged from 38% to 76% by program and state. Differences by race/ethnicity were inconsistent and small: African Americans had lower HAART use by 6%-14% in California and Florida Medicaid, and Latinos had higher HAART use by 2%-11% in ADAP and in Texas Medicaid.
African Americans were more likely to access HIV drugs through Medicaid than through ADAP, which may reflect differences in program eligibility criteria as well as care seeking later in HIV disease. Differences in the use of HAART by race/ethnicity within state programs were small.
研究1998年四个州医疗补助计划（Medicaid）和艾滋病药物援助计划（ADAP）中不同种族/族裔群体获取和使用高效抗逆转录病毒疗法（HAART）的情况。
作者分析了加利福尼亚州、佛罗里达州、纽约州和得克萨斯州的报销申请和艾滋病监测数据。通过特定的HIV诊断或用药代码来确定研究对象。将项目参保者的种族/族裔与HIV疫情中的占比进行比较，以研究获取情况。将抗逆转录病毒药物（ARV）使用的申请与美国公共卫生服务部的治疗指南进行比较，以评估HAART的使用情况。
作者在这四个州的这两个项目中识别出151,000名HIV感染者。医疗补助计划中78%-88%的参保者有艾滋病或有症状的HIV证据，而艾滋病药物援助计划中的这一比例为31%-48%。非裔美国人参与医疗补助计划的比例比疫情中的占比高10%-53%，参与艾滋病药物援助计划的比例比疫情中的占比低17%-31%。非拉丁裔白人呈现相反的模式，参与医疗补助计划的比例比疫情中的占比低5%-38%，参与艾滋病药物援助计划的比例比疫情中的占比高9%-65%。拉丁裔参与艾滋病药物援助计划的比例更高（7%-31%），纽约州除外。按项目和州划分，90天以上（7月至9月）的HAART使用率在38%至76%之间。种族/族裔之间的差异不一致且较小：在加利福尼亚州和佛罗里达州的医疗补助计划中，非裔美国人的HAART使用率低6%-14%，在艾滋病药物援助计划和得克萨斯州的医疗补助计划中，拉丁裔的HAART使用率高2%-11%。
非裔美国人通过医疗补助计划获取HIV药物的可能性高于通过艾滋病药物援助计划，这可能反映了项目资格标准的差异以及在HIV疾病后期寻求治疗的情况。州项目中不同种族/族裔在HAART使用上的差异较小。
